A clustering based on the dynamics of DSM-5 criteria for gambling disorder: A 5-year follow-up of gamblers with and without gambling disorder

Background and aims: Gambling disorder (GD) follows a non-linear progression over time. Beyond shifts between disordered and non-disordered gambling statuses, the presence of each DSM-5 diagnostic criteria for GD may fluctuate throughout a gambler's trajectory. This study aimed to identify clusters of gamblers based on the evolution of the nine GD diagnostic criteria over time and to characterize these clusters using clinical variables. Methods: Data were drawn from the JEU cohort (NCT01207674), a multicenter study of adult gamblers with and without GD, featuring a five-year follow-up. Participants completed structured clinical interviews and self-report questionnaires at baseline and annually. The analysis included only individuals who completed at least one follow-up assessment and met at least one GD diagnostic criterion during the study period (n = 209). A mixture model was applied to estimate the probability of meeting each GD criterion over time. Results: Four distinct clusters emerged, characterized by a gradient of GD severity and specific criterion-based evolutions. Some criteria fluctuated alongside overall GD severity, while others, particularly "loss of control", persisted even when severity decreased. Additionally, three criteria ("lying", "jeopardization" and "bailout") were more likely to be present only in the two most severe clusters. Discussion and conclusions: This study confirms that, beyond the fluctuations of GD states, the presence of individual criteria also varies over time. These findings provide new insights into the dynamic progression of GD and may help tailor therapeutic approaches to better address the specific needs of gamblers at different stages of the disorder.