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• Bipolar Disorder Gambling Problems
• Bipolar Disorder Gambling Problem Solving
• Problems With Bipolar Disorder
• Bipolar Disorder In Children

Gambling addicts are significantly more likely to have mental health disorders or substance abuse problems. The statistics are bracing. Bipolar disorder can be difficult to diagnose on its own. When paired with substance abuse, it can become a hotbed of issues, misunderstandings, and incorrect treatment. When the correct diagnosis is finally reached, patients often wonder how this problem was missed for so long. Sometimes people who have bipolar disorder gamble a lot while they are having a manic episode. 5  This is not a gambling disorder, even though the behaviors and the consequences can be similar. Bipolar Disorder Outlook. For most people, a good treatment program can stabilize their moods and help ease symptoms. Those who also have a substance abuse problem may need more specialized treatment. Oftentimes, a person with a gambling addiction also suffers from bipolar disorder, depression, ADHD or obsessive-compulsive disorder, so medication or therapy to treat those conditions can alleviate gambling addiction. Gamblers Anonymous and other self-help groups help many people as well. Deciding Between Gambling Addiction Solutions.

Excessive gambling can drain finances, ruin personal and professional relationships, and harm the gambler’s mental health. Gambling disorder affects about 1% of Americans who can’t stop, despite the consequences. Gambling covers more than a trip to the casino or an illicit poker game – it includes lotteries, online poker, and sports betting, and there's a debate over whether it also includes daily fantasy sports leagues.

Yale Medicine is a leader in gambling disorder treatment research, with one of two Centers of Excellence in gambling research in the nation financed by the National Center for Responsible Gaming located at Yale. We take a multidisciplinary approach, including brain imaging, pharmacology, and genetics, to investigate the neurobiology and treatment of gambling disorder.

Risk factors for gambling disorder may include:

• Sex. Men are more likely to have gambling problems than women, but the disparity seems to have narrowed in recent years. Men appear more drawn to such strategic forms of gambling as card games or sports betting, while women tend to prefer such non-strategic forms as bingo or slot machines.
• Age. Two to 7% of youths develop a gambling disorder, compared with about 1% of adults, and many gambling disorders begin in adolescence. College students also gamble at higher rates than the general population.
• Family. People who have a parent with a gambling problem are more likely to have problems too. Yale research is working to understand the connection between genetics and gambling disorders. It’s estimated that a gambling disorder’s development is 50 percent due to genetic factors and 50 percent due to environmental factors.
• Other behavior or mood disorders. People with gambling disorder often abuse alcohol, tobacco, or other drugs, have mood or personality disorders such as schizophrenia or antisocial personality disorder, or have attention deficit hyperactivity disorder (ADHD). A 2008 study showed that people with psychiatric disorders are 17 times more likely to develop gambling problems.
• Personality traits. People who tend to be restless, easily bored, extremely hard-working, or very competitive may be at greater risk of developing gambling disorder.

What’s the difference between enjoying gambling and gambling disorder?

Most adults who gamble do not have a gambling disorder, but those who do can face very serious problems. An afflicted gambler may deplete savings, borrow money, or liquidate retirement accounts to finance their gambling, damage personal relationships (especially with a spouse and family), and have troubles at work. People with a gambling disorder often feel guilt or shame and may experience such withdrawal symptoms as restlessness and irritability when attempting to stop gambling.

Many people may take gambling lightly, not realizing that it may be addictive in many of the same ways as drugs are. Gambling problems can be very harmful to affected individuals and their families.

People who, over a 12-month period meet four of these nine criteria devised by the American Psychiatric Association, are considered to have a gambling disorder:

• Need to gamble with increasing amounts of money in order to achieve the desired excitement
• Are restless or irritable when attempting to cut down or stop gambling
• Have made repeated unsuccessful efforts to control, cut back, or stop gambling
• Are often preoccupied with gambling (e.g. having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble)
• Often gamble when feeling distressed (e.g. helpless, guilty, anxious, depressed)
• After losing money gambling, often return another day to get even (“chasing” one’s losses)
• Lie to conceal the extent of involvement with gambling
• Have jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
• Rely on others to provide money to relieve desperate financial situations caused by gambling

What are the treatment options for gambling disorder?

There are three main forms of interventions:

• Psychotherapy. Individual and group approaches such as cognitive behavioral therapy, which helps to identify and modify damaging thinking and behavior, can help people overcome the problem. Another method is motivational interviewing, which helps to turn ambivalence about quitting into motivation to quit and can help patients combat urges to gamble.
• Medications. There are multiple potential pharmaceutical approaches to treatment, although no medication has an FDA indication for gambling disorder. Such opioid antagonists as naltrexone and nalmefene, which may reduce cravings for alcohol, have been found in randomized clinical trials to be superior to placebo in the treatment of gambling disorders. The antidepressant and antianxiety medication escitalopram may help decrease anxiety and problem-gambling severity in people with co-occurring anxiety and gambling disorders. The mood stabilizer lithium has been shown to reduce mania and problem-gambling severity in individuals with co-occurring bipolar-spectrum and gambling disorders. However, most medication trials have been relatively short-term and have involved small sample sizes.
• Support groups. Some people with gambling disorder find help with such groups as Gamblers Anonymous, a 12-step program dedicated to abstinence. Participants meet and share experiences, supporting each other in their efforts to abstain from gambling.

What makes Yale Medicine’s gambling disorder research unique?

Yale’s Center of Excellence in Gambling Research, one of two such centers in the nation, is supported by the National Center for Responsible Gaming and conducts groundbreaking research into gambling disorder.

The Center, directed by Yale Medicine psychiatrist Marc Potenza, MD, PhD, has conducted the first brain imaging studies on people with gambling problems. The functional imaging investigations, along with volumetric and neurochemical studies, have found that the brain acts similarly during monetary reward processing in individuals with gambling disorder as it does in people with binge-eating, alcohol-use and tobacco-use disorders. Yale Medicine research has made advances in understanding the effects of such opioid antagonist medications as naltrexone and nalmefene on gambling problems (including planning and participating in the largest multi-center, randomized clinical trial thus far to investigate pharmacotherapy for treating gambling disorder). The Yale Center has also investigated gender-related differences in gambling behaviors and disorders. Next for the Center is tracking the brain’s activity during effective behavioral and pharmacological treatments.

Dr. Potenza is also director of the Problem Gambling Clinic, a collaboration between the Yale Department of Psychiatry and the Connecticut Mental Health Center, which treats patients and conducts research into gambling disorder. He is also a consulting psychiatrist for and medical director of the New Haven component of the Bettor Choice program operated through The Connection.

Does your child go through extreme changes in mood and behavior? Does your child get much more excited or much more irritable than other kids? Do you notice that your child goes through cycles of extreme highs and lows more often than other children? Do these mood changes affect how your child acts at school or at home?

Some children and teens with these symptoms may have bipolar disorder, a brain disorder that causes unusual shifts in mood, energy, activity levels, and day-to-day functioning. With treatment, children and teens with bipolar disorder can get better over time.

What is bipolar disorder?

Bipolar disorder is a mental disorder that causes people to experience noticeable, sometimes extreme, changes in mood and behavior. Sometimes children with bipolar disorder feel very happy or “up” and are much more energetic and active than usual. This is called a manic episode. Sometimes children with bipolar disorder feel very sad or “down” and are much less active than usual. This is called a depressive episode.

Bipolar disorder, which used to be called manic-depressive illness or manic depression, is not the same as the normal ups and downs every child goes through. The mood changes in bipolar disorder are more extreme, often unprovoked, and accompanied by changes in sleep, energy level, and the ability to think clearly. Bipolar symptoms can make it hard for young people to perform well in school or to get along with friends and family members. Some children and teens with bipolar disorder may try to hurt themselves or attempt suicide.

Most people are diagnosed with bipolar disorder in adolescence or adulthood, but the symptoms can appear earlier in childhood. Bipolar disorder is often episodic, but it usually lasts a lifetime.

Signs and symptoms of bipolar disorder may overlap with symptoms of other disorders that are common in young people, such as attention-deficit/hyperactivity disorder (ADHD), conduct problems, major depression, and anxiety disorders. Diagnosing bipolar disorder can be complicated and requires a careful and thorough evaluation by a trained, experienced mental health professional.

With treatment, children and teens with bipolar disorder can manage their symptoms and lead successful lives.

What causes bipolar disorder?

The exact causes of bipolar disorder are unknown, but several factors may contribute to the illness.

For example, researchers are beginning to uncover genetic mechanisms that are linked to bipolar disorder and other mental disorders. Research shows that people’s chance of having bipolar disorder is higher if they have a close family member with the illness, which may be because they have the same genetic variations. However, just because one family member has bipolar disorder, it does not mean that other members of the family will have it. Many genes are involved in the disorder, and no single gene causes it.

Bipolar Disorder Gambling Problems

Research also suggests that adversity, trauma, and stressful life events may increase the chances of developing bipolar disorder in people with a genetic risk of having the illness.

Some research studies have found differences in brain structure and function between people who have bipolar disorder and those who do not. Researchers are studying the disorder to learn more about its causes and effective treatments.

What are the symptoms of bipolar disorder?

Mood episodes in bipolar disorder include intense emotions along with significant changes in sleep habits, activity levels, thoughts, or behaviors. A person with bipolar disorder may have manic episodes, depressive episodes, or “mixed” episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that often last for several days or weeks. During an episode, the symptoms last every day for most of the day.

Bipolar Disorder Gambling Problem Solving

These mood and activity changes are very different from the child’s usual behavior and from the behavior of healthy children and teens.

Children and teens having a manic episode may:

• Show intense happiness or silliness for long periods of time.
• Have a very short temper or seem extremely irritable.
• Talk fast about a lot of different things.
• Have trouble sleeping but not feel tired.
• Have trouble staying focused, and experience racing thoughts.
• Seem overly interested or involved in pleasurable but risky activities.
• Do risky or reckless things that show poor judgment.

Children and teens having a depressive episode may:

• Feel frequent and unprovoked sadness.
• Show increased irritability, anger, or hostility.
• Complain a lot about pain, such as stomachaches and headaches.
• Have a noticeable increase in amount of sleep.
• Have difficulty concentrating.
• Feel hopeless and worthless.
• Have difficulty communicating or maintaining relationships.
• Eat too much or too little.
• Have little energy and no interest in activities they usually enjoy.
• Think about death, or have thoughts of suicide.

Can children and teens with bipolar disorder have other problems?

Young people with bipolar disorder can have several problems at the same time. These include:

• Misuse of alcohol and drugs. Young people with bipolar disorder are at risk of misusing alcohol or drugs.
• Attention-deficit/hyperactivity disorder (ADHD). Children and teens who have both bipolar disorder and ADHD may have trouble staying focused.
• Anxiety disorders. Children and teens with bipolar disorder also may have an anxiety disorder.

Sometimes extreme behaviors go along with mood episodes. During manic episodes, young people with bipolar disorder may take extreme risks that they wouldn’t usually take or that could cause them harm or injury. During depressive episodes, some young people with bipolar disorder may think about running away from home or have thoughts of suicide.

If your child shows signs of suicidal thinking, take these signs seriously and call your child’s health care provider.

If you think your child is in crisis and needs immediate help, call 911. You also can call the National Suicide Prevention Lifeline (Lifeline) at 1‑800‑273‑TALK (8255), or text the Crisis Text Line (text HELLO to 741741). The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. These services are confidential, free, and available 24/7.

How is bipolar disorder diagnosed?

A health care provider will ask questions about your child’s mood, sleeping patterns, energy levels, and behavior. There are no blood tests or brain scans that can diagnose bipolar disorder. However, the health care provider may use tests to see if something other than bipolar disorder is causing your child’s symptoms. Sometimes health care providers need to know about medical conditions in the family, such as depression or substance use.

Other disorders have symptoms like those of bipolar disorder, including ADHD, disruptive mood regulation disorder, oppositional defiant disorder, conduct disorder, and anxiety disorders. It also can be challenging to distinguish bipolar disorder from depression that occurs without mania, which is referred to as “major depression.” A health care provider who specializes in working with children and teens can make a careful and complete evaluation of your child’s symptoms to provide the right diagnosis.

How is bipolar disorder treated?

Children and teens can work with their health care provider to develop a treatment plan that will help them manage their symptoms and improve their quality of life. It is important to follow the treatment plan, even when your child is not currently experiencing a mood episode. Steady, dependable treatment works better than treatment that starts and stops.

Treatment options include:

• Medication. Several types of medication can help treat symptoms of bipolar disorder. Children respond to medications in different ways, so the right type of medication depends on the child. This means children may need to try different types of medication to see which one works best for them. Some children may need more than one type of medication because their symptoms are complex. Children should take the fewest number of medications and the smallest doses possible to help their symptoms. A good way to remember this is “start low, go slow.” Medications can cause side effects. Always tell your child’s health care provider about any problems with side effects. Do not stop giving your child medication without speaking to a health care provider. Stopping medication suddenly can be dangerous and can make bipolar symptoms worse.
• Psychosocial Therapy. Different kinds of psychosocial therapy can help children and their families manage the symptoms of bipolar disorder. Therapies that are based on scientific research—including cognitive behavioral approaches and family-focused therapy—can provide support, education, and guidance to youth and their families. These therapies teach skills that can help people manage bipolar disorder, including skills for maintaining routines, enhancing emotion regulation, and improving social interactions.

What can children and teens expect from treatment?

With treatment, children and teens with bipolar disorder can get better over time. Treatment is more effective when health care providers, parents, and young people work together.

Sometimes a child’s symptoms may change, or disappear and then come back. When this happens, your child’s health care provider may recommend changes to the treatment plan. Treatment can take time, but sticking with the treatment plan can help young people manage their symptoms and reduce the likelihood of future episodes.

Your child’s health care provider may recommend keeping a daily life chart or mood chart to track your child’s moods, behaviors, and sleep patterns. This may make it easier to track the illness and see whether treatment is working.

How can I help my child or teen?

Help begins with the right diagnosis and treatment. Talk to your family health care provider about any symptoms you notice.

If your child has bipolar disorder, here are some basic things you can do:

• Be patient.
• Encourage your child to talk, and listen to your child carefully.
• Pay attention to your child’s moods, and be alert to any major changes.
• Understand triggers, and learn strategies for managing intense emotions and irritability.
• Help your child have fun.
• Remember that treatment takes time: sticking with the treatment plan can help your child get better and stay better.
• Help your child understand that treatment can make life better.

How does bipolar disorder affect caregivers and families?

Caring for a child or teenager with bipolar disorder can be stressful for parents and families. Coping with a child’s mood episodes and other problems—such as short tempers and risky behaviors—can challenge any caregiver.

It is important that caregivers take care of themselves, too. Find someone you can talk to or consult your health care provider about support groups. Finding support and strategies for managing stress can help you and your child.

Where do I go for help?

Problems With Bipolar Disorder

If you’re not sure where to get help, your doctor, pediatrician, or other family health care provider is a good place to start. A health care provider can refer you to a qualified mental health professional, such as a psychiatrist or psychologist, who has experience treating bipolar disorder and can evaluate your child’s symptoms.

You can learn more about getting help and finding a health care provider on the National Institute of Mental Health website. Hospital health care providers can help in an emergency. The Substance Abuse and Mental Health Services Administration (SAMHSA) has an online tool to help you find mental health services in your area.

I know someone who is in crisis. What do I do?

If you know someone who might be thinking about hurting themselves or someone else, get help quickly.

• Do not leave the person alone.
• Call 911 or go to the nearest hospital emergency room.
• Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the toll-free TTY number at 1-800-799-4TTY (4889). You also can text the Crisis Text Line (text HELLO to 741741) or go to the National Suicide Prevention Lifeline website.

What should I know about clinical trials?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct clinical trials with patients and healthy volunteers. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you. For more information, visit the NIMH Clinical Trials webpage.

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For More Information

MedlinePlus (National Library of Medicine) (En español)

ClinicalTrials.gov (En español)

Bipolar Disorder In Children

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 20-MH-8081
Revised 2020